In a series of 161 consecutive patients with severe closed head injuries which were rated 8 or less on Glasgow Coma Scale (GCS), 85 patients received barbiturates intravenously (i.e. thiamylal or pentobarbital) to protect against brain damage and control intracranial pressure (ICP). Thiamylal was given to 69 patients. The initial dose of thiamylal was 30 mg/kg and the maintenance dose was 3.20±0.16 (average±SE) mg/kg/hr for 2 ?? 7 days. Pentobarbital was given to 16 cases at a dose of 1.19±0.13 mg/kg/hr. Seventy-six patients who did not receive barbiturates were used as controls. These patients were controlled under moderate hyperventilation (PaCO₂ was between 25 ?? 30 mmHg and PaO₂ remained at 80 to 150 mmHg). Since barbiturate-coma was made it impossible to assess the neurological status, it was necessary to follow ICP, EEG and serial CT scans. All of these patients received pharmacologically high doses of beta-methasone. It was usually possible to obtain CT scans within one hour after admission. If necessary, osmotic agents were given and/or appropriate surgical procedures were performed. ICP was monitored in 34 patients of the barbiturate group using an epidural sensor or a subarachnoid catheter.
The mortality rate was 40% in the barbiturate group and 48.7% in the control group. The barbiturate group with GCS ratings of 3, 4, 5 or 6 showed a lower mortality rate than the control group with the corresponding GCS ratings, but these differences were not statistically significant. In GCS 3/4 group, mortality in the barbiturate group was 63.6%, whereas that of the control group was 89.7%. The difference was statistically significant (X²=5.69, P<0.02).
Barbiturate overloading might reduce the mortality in severe closed head injury patients.